Journal of medical ethics
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Prescription opioid abuse (POA) is an escalating clinical and public health problem. Physician worries about iatrogenic addiction and whether patients are 'drug seeking', 'abusing' and 'diverting' prescription opioids exist against a backdrop of professional and legal consequences of prescribing that have created a climate of distrust in chronic pain management. One attempt to circumvent these worries is the use of opioid contracts that outline conditions patients must agree to in order to receive opioids. ⋯ If patients distrust their physician, or feel distrusted by them, this may destabilise the therapeutic relationship and compromise care. A process of epistemic humility may help cultivate mutual patient-physician trust. Epistemic humility is a collaborative effort between physicians and patients that recognises the role of patients' subjective knowledge in enhancing physicians' self-understanding of their theoretical and practice frameworks, values and assumptions about the motivations of certain patients who report chronic pain.
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Anaesthesia causes unconsciousness by suppressing neural mechanisms mediating arousal and awareness. It also causes amnesia by disrupting mechanisms of memory consolidation. Some patients under general anaesthesia unexpectedly become aware during surgery and form a traumatic memory of their experience. ⋯ In cases where awareness is detected intraoperatively, I consider whether an anaesthetist would be justified in administering a drug to prevent a memory of the experience, as well as reasons for and against preoperatively informing patients of the possibility of awareness. In cases where awareness is reported postoperatively, I consider reasons for taking a drug to erase a memory of awareness against reasons for retaining the memory. A decision to take or decline such a drug would be informed by the potential harm of these memories and the potential benefits and risks of drugs intended to erase them.
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Journal of medical ethics · Oct 2014
Research funding and authorship: does grant winning count towards authorship credit?
It is unclear whether or not grant winning should count towards authorship credit in the sciences. In this paper, I argue that under certain circumstances grant winning can count for credit as an author on subsequent works. It is a mistake to think that grant winning is always irrelevant to the correct attribution of authorship.